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Voices from the Field: Understanding Our Strengths

Voices from the Field: Understanding Our Strengths

By Roshan Najafi

Roshan Najafi is currently in her first year of family medicine residency at the University of Washington in Seattle. She served as an FSD intern in Kakamega, Kenya during the summer of 2010 where she worked at the Shibwe Sub-district Hospital. There, she worked with community members on an initiative that included restructuring of the hospital to build a new female inpatient ward. She hopes to continue international work, with interest in health education, capacity building, and community development.

Fields of maize surrounded us as we drove along the Sigalagala mud road on the way to Shibwe village where I was to start my work as an intern at the Shibwe Sub-district Hospital. We arrived at a compound with two small huts. Nancy, my Kenyan host sister, gave me a tour: mud hut kitchen, stone fireplace for cooking, and a pit latrine outside next to the cows. There was intermittent electricity and no running water. As my program director drove away, I was nervous, though excited, wondering what this new experience might hold.

Nancy was kind and gentle, and calmed me with her reassurances. She was pregnant, her baby in breech position, and worried at the possibility of a Cesarean section. We were both nervous – Nancy comforted me, and I did the same for her by sharing my limited knowledge of a Cesarean, looking at her ultrasound images and describing the procedure. On that first day in Shibwe, I learned that the personal connections we make with others are often those that help us heal the most.

In fact was this very opportunity to make personal, meaningful connections with members of the Shibwe community that made the FSD experience so unique. While the hospital serves several thousand people in neighboring villages, its smaller size provided the chance to become closely acquainted with its staff who each had an important role to play in maintaining the hospital. Furthermore, the location of the hospital served as a community hub in and of itself - local fruit and vegetable vendors sold their goods outside its gates, local buses picked up and dropped off passengers hourly, and residents would catch up on local happenings just nearby. As a result, it was essential to understand and engage community members as well in developing a sustainable initiative that would benefit the community as a whole.

As part of the FSD team in Shibwe, I was given the opportunity to listen to my colleagues, community health workers, and neighbors in the community as they told me of their personal strengths, the challenges they had overcome, and how the hospital could work to empower the community. Together, we highlighted the skills of those around us that could strengthen the hospital and its ability to provide effective patient care. By focusing on the assets we could bring to our project goals, we were better prepared to address the hospital’s limitations and what could be improved upon.

Ultimately, we recognized that by restructuring several of the hospital wards, we could maximize hospital space and improve patient quality of care. There was a larger building that had been built several years prior but remained unfinished; space was tight in the remaining wards, particularly during the summer time when malaria and typhoid fever are common, requiring prompt hospital care. Our initiative aimed to restructure the hospital and build a new female inpatient ward in the unfinished building while making more efficient use of the previously existing rooms. Having made personal connections with individuals in the community, I was introduced to the local village carpenter, a local electrician, and community members who felt empowered to play an active role in our initiative. The enthusiasm we all shared was tangible, and appeared contagious as more community members heard of our work. Even the owner of the next-door family-owned restaurant where I often went for lunch chapatis approached me and asked to be involved; he happened to work as a metal welder, and asked to contribute in building additional bed frames for the new ward. Indeed, one of the most rewarding aspects of my work with FSD was the recognition that everyone’s efforts would have a direct impact on their very own community; as a result, there was a developing sense of pride that was inspiring to witness and be a part of.

By the end of my time in Shibwe, we were able to see the completion and opening of the new ward. Additionally, near the end of my time in Kenya, Nancy delivered her baby naturally, without complications. She named her daughter Roshan.

I had the opportunity to return to Shibwe several years after finishing my internship. It was incredible to witness what had come of our efforts - our collaborations had empowered the community members who had sourced their skills in our hospital initiative to play an active role in developing new initiatives to improve the community as a whole, and the hospital had been able to care for an increased patient load while maintaining quality of care. It was great to reconnect with the community that had left an indelible mark on me.

My experience working with the incredible FSD staff and the Shibwe community was one I will never forget, and I am thankful for such an eye-opening and humbling opportunity.